Provider Demographics
NPI:1982627766
Name:BUCKNER, BRENDA (PHD)
Entity Type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:
Last Name:BUCKNER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 HOUSTON AVE
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76086-4316
Mailing Address - Country:US
Mailing Address - Phone:817-596-8410
Mailing Address - Fax:
Practice Address - Street 1:206 HOUSTON AVE
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086-4316
Practice Address - Country:US
Practice Address - Phone:817-596-8410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12245101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional